Lunch at the Labs

Various web links I found to be of interest recently.

• Researchers have ditched the autism-vaccine hypothesis. Here's what they think actually causes it.

  Genes and the microbiome are some of the most promising leads.

  Today, about one in 68 US children has autism -- a rate that's remained unchanged since at least 1990, though there's been a steady increase in awareness and diagnosis.
  ...
  But "of all the causes of autism, the thing we know with the greatest certainty is that it's a very genetic disorder," said UCSF geneticist and autism researcher Stephan Sanders. "If you look at a child with autism, then look at their siblings, you'll find the rate of autism is 10 times higher in those siblings than in the general population. This has been looked at in populations of millions."
  ...
  Overall, the evidence for these prenatal exposures is stronger than the evidence for the range of postnatal causes that may trigger autism, said Amaral.

• Why You're Biased About Being Biased

  Such biases can still affect you even if you know all about them because they operate unconsciously. We judge whether we have a bias by examining our thoughts, and because we believe our thoughts are rational, we often think we're not biased when we are. Psychologists call this contradiction the "bias blind spot." Although we're quick to see biases in others, we have more trouble noticing them in ourselves.

  And the more we convince ourselves that we don't have certain biases, the more likely we are to exhibit them. If we believe we're good people, for example, we may stop trying to be better and may be more likely to act indecently. Similarly, if we think we're smart, we might skip studying for a test and give ignorant answers. In general, if we believe we're unbiased, we're giving ourselves permission to be biased.

• Why We Believe -- Long After We Shouldn't

  Carol Tavris and Elliot Aronson in Skeptical Inquirer

  That's motivated cognition; people are emotionally motivated to reject findings that threaten their core beliefs or worldview.
  ...
  The key motivational mechanism that underlies the reluctance to change our minds, to admit mistakes, and to be unwilling to accept unwelcome scientific findings is cognitive dissonance -- the discomfort we feel when two cognitions, or cognition and behavior, contradict each other.
  ...
  Dissonance theory comprises three cognitive biases in particular:

  1. The bias that we, personally, don't have any biases-the belief that we perceive objects and events clearly, as they really are. Any opinion I hold must be reasonable; if it weren't, I wouldn't hold it.
  2. The bias that we are better, kinder, smarter, more moral, and nicer than average.
  3. The confirmation bias, the fact that we notice and remember information that confirms what we believe and ignore, forget,

• How One Little Cable Company Exposed Telecom's Achilles' Heel

  Forget net neutrality--the real fight is over controlling price-gouging monopolies.

  Here's the reality: The details of the net neutrality rules adopted by the FCC in February 2015 were not important to AT&T, Verizon, Comcast, Spectrum, or CenturyLink. What was important was the idea that any part of the government might have enforceable oversight over their data transmission services or charges. That's what they can't stand; that's what they would do anything to avoid. And that's what they are working to undo: the FCC's classification of them as "common carriers" under "Title II" of the Telecommunications Act.

• The Inadequacies of the Invincible

  On the Failure of Stoic Ethics

  The rise of Stoicism is a sign of a civilization in decline. There is something decadent about a society trying to escape its own loss through a sour grapes philosophy. Let us face reality. The answer isn't in the flick of the mind. We could come together with our friends- decide what we require of each other - and turn back the tide of decline.

  This doesn't mean we shouldn't try to master our volatility when the chips are down or that powerful reactions to false beliefs are healthy. Our emotions can be off, ill-fitting to a situation. But perhaps all we need is a good night's rest, less junk food, some time with friends, and good exercise. All of these help us gain emotional stability better than the sphincter squeezing contortions of Stoic impulse control.

• The Reactionary Temptation

  An open-minded inquiry into the close-minded ideology that is the most dominant political force of our time - and can no longer be ignored. By Andrew Sullivan

  Reactionism is not the same thing as conservatism. It's far more potent a brew. Reactionary thought begins, usually, with acute despair at the present moment and a memory of a previous golden age. It then posits a moment in the past when everything went to hell and proposes to turn things back to what they once were. It is not simply a conservative preference for things as they are, with a few nudges back, but a passionate loathing of the status quo and a desire to return to the past in one emotionally cathartic revolt. If conservatives are pessimistic, reactionaries are apocalyptic. If conservatives value elites, reactionaries seethe with contempt for them. If conservatives believe in institutions, reactionaries want to blow them up. If conservatives tend to resist too radical a change, reactionaries want a revolution. Though it took some time to reveal itself, today's Republican Party - from Newt Gingrich's Republican Revolution to today's Age of Trump - is not a conservative party. It is a reactionary party that is now at the peak of its political power.

Some interesting links related to health care in the U.S.

• Mayo Clinic researchers demonstrate value of second opinions

  Many patients come to Mayo Clinic for a second opinion or diagnosis confirmation before treatment for a complex condition. In a new study, Mayo Clinic reports that as many as 88 percent of those patients go home with a new or refined diagnosis -- changing their care plan and potentially their lives. Conversely, only 12 percent receive confirmation that the original diagnosis was complete and correct.

• The two major sources of our healthcare problem

  The first original sin appeared in the 1940s, when the government agreed to allow companies to deduct the cost of health insurance, but neglected to allow individuals to do the same. (I've discussed this in a number of posts over the years.) This made health insurance provided by employers much cheaper than health insurance purchased by individuals. Not only that, but it created a strong incentive for employers to offer health insurance which covered a whole lot of things; and why not, if the costs were uniquely deductible by companies?
  ...
  The second original sin, Cochrane argues, is that "Instead of straightforwardly raising taxes in a non-distortionary way (a VAT, say), and providing charity care or subsidies -- on budget, please, where we can see it -- our political system prefers to fund things by forcing cross subsidies. Medicare and medicaid don't pay what the service costs, because we don't want to admit just how expensive that service is. So, large hospitals make up the difference by overcharging you and me instead."

• US healthcare: most people don't know what they're talking about

  In fact in the US case it's not even obesity, or indeed their greater pre-existing disease burden, that is doing most of the work in dragging their life expectancy down; it's accidental and violent deaths. It is tragic that the US is so dangerous, but it's not the fault of the healthcare system; indeed, it's an extra burden that US healthcare spending must bear. Just simply normalising for violent and accidental death puts the USA right to the top of the life expectancy rankings.
  ...
  Now this is not to say the US system works well. The fact that the US spends vastly more than everyone else, and only does a bit better, if that, makes the system pretty unimpressive. But it's important to understand why. The UK really does have "death panels" that refuse treatments because they're extremely costly relative to their tiny impact. The USA has a system where most people can buy--are even subsidised through the tax system to buy--insurance that is as extensive as they like, paying for ever more expensive and marginally beneficial therapies. Eventually you're spending a fifth of your GDP on it.

• The secret monopoly behind America's outrageous drug prices

  The details of the PBM (pharmacy benefit managers) architecture are extraordinarily complicated, as Dayen's piece explains. But the basic idea is reasonably straightforward. PBMs date back to the 1960s, when they served as streamlined claims processors to intermediate between pharmacies and drug companies. As the industry grew, PBMs presented themselves as a way to keep drug prices low because they could "form large patient networks, and negotiate discounts from both drug companies and pharmacies, which would have no choice but to contract with them to access the network."

  Sounds reasonable enough. But over time, two big things changed: The health-care billing system got more and more hideously complex, and virtually all the PBMs were rolled up into three big companies -- ExpressScripts, CVS Caremark, and OptumRx, which now control a combined 75 to 80 percent of the market. As a result, the promised savings have not materialized. On the contrary, spending on prescription drugs exploded by 1,100 percent between 1987 and 2014, and all three companies -- which are each among the top 22 of the Fortune 500 -- rake in huge profits. Dayen reports that ExpressScripts' adjusted profit per prescription has increased by 500 percent since 2003.